Study design including screening, group allocation, and follow-up.

<p>A total of 319 children from 16 classes were invited from among 3,840 children screened from 183 classes. The schools were assigned to either the intervention or the control arms by simple randomization using a coin toss.</p

Effect of a One-Off Educational Session about Enterobiasis on Knowledge, Preventative Practices, and Infection Rates among Schoolchildren in South Korea

<div><p>Although health education has proven to be cost-effective in slowing the spread of enterobiasis, assessments of the effectiveness of health education to reduce infectious diseases specifically in children are rare. To evaluate the effect of health education on knowledge, preventative practices, and the prevalence of enterobiasis, 319 children from 16 classes were divided into experimental and control groups. Data were collected from May 2012 to March 2013. A 40-minute in-class talk was given once in the experimental group. There were significant differences over the time in the mean scores for children's knowledge of <i>Enterobius vermicularis</i> infection in the intervention group compared to the control group (<i>p</i><0.001). After the educational session, the score for knowledge about <i>E. vermicularis</i> infection increased from 60.2±2.32 to 92.7±1.19 in the experimental group; this gain was partially lost 3 months later, decreasing to 83.6±1.77 (<i>p</i><0.001). Children's enterobiasis infection prevention practice scores also increased, from 3.23±0.27 to 3.73±0.25, 1 week after the educational session, a gain that was partially lost at 3 months, decreasing to 3.46±0.36 (<i>p</i><0.001). The overall <i>E. vermicularis</i> egg detection rate was 4.4%; the rates for each school ranged from 0% to 12.9% at screening. The infection rate at 3 months after the treatment sharply decreased from 12.3% to 0.8% in the experimental group, compared to a decrease from 8.5% to 3.7% in the control group during the same period. We recommend that health education on enterobiasis be provided to children to increase their knowledge about enterobiasis and improve prevention practices.</p></div

Characteristics of study sites and individual participants (n = 319).

<p>Characteristics of study sites and individual participants (n = 319).</p

Assessment of children's correct answer rates on <i>E. vermicularis</i> infection knowledge test (Experimental group: n = 130).

<p>Assessment of children's correct answer rates on <i>E. vermicularis</i> infection knowledge test (Experimental group: n = 130).</p

Comparison of the prevalence of <i>E. vermicularis</i> egg positive rates, knowledge, and prevention practices for <i>E. vermicularis</i> infection between groups (n = 319).

<p>*Statistically significant between baseline and 3 months in experimental group (p<0.001) and control group (<i>p</i> = 0.049), based on the McNemar test.</p>†<p>OR was adjusted for clusters as a random effect.</p>‡<p>Mean difference was adjusted for clusters as a random effect, as well as gender and age.</p><p>Comparison of the prevalence of <i>E. vermicularis</i> egg positive rates, knowledge, and prevention practices for <i>E. vermicularis</i> infection between groups (n = 319).</p

Egg positive rates of <i>E. vermicularis</i> infection among children in South Korea (n = 3840).

<p>Egg positive rates of <i>E. vermicularis</i> infection among children in South Korea (n = 3840).</p

Activation of BMDCs by ES proteins.

<p>Expression of cell surface markers (MHCII, CD40, CD80, and CD86) on mouse BMDCs pulsed with ES proteins or LPS for 48 hr, compared with expression in untreated cells. (three independent experiments).</p

<i>Acanthamoeba</i>-specific IgE levels in asthma patients and <i>Acanthamoeba</i>-specific antigens in house dust.

<p>(A) After serum absorption with Der P1 and <i>Aspergillus</i> protease, the levels of <i>Acanthamoeba</i>-specific IgE in the sera of asthma patients were evaluated by ELISA. (B) Control: sera of 9 healthy individuals; Asthma: sera of 25 asthma patients. Immune-plates were coated with 5 μg/ml of house dust solution and then incubated with diluted serum (1:500) from <i>Acanthamoeba</i>-infected mice. Specific IgG1 levels were estimated by ELISA. (*<i>p</i><0.05, **<i>p</i><0.01, ***<i>p</i><0.001).</p

<i>Acanthamoeba</i> Protease Activity Promotes Allergic Airway Inflammation via Protease-Activated Receptor 2

<div><p><i>Acanthamoeba</i> is a free-living amoeba commonly present in the environment and often found in human airway cavities. <i>Acanthamoeba</i> possesses strong proteases that can elicit allergic airway inflammation. To our knowledge, the aeroallergenicity of <i>Acanthamoeba</i> has not been reported. We repeatedly inoculated mice with <i>Acanthamoeba</i> trophozoites or excretory-secretory (ES) proteins intra-nasally and evaluated symptoms and airway immune responses. <i>Acanthamoeba</i> trophozoites or ES proteins elicited immune responses in mice that resembled allergic airway inflammation. ES proteins had strong protease activity and activated the expression of several chemokine genes (<i>CCL11</i>, <i>CCL17</i>, <i>CCL22</i>, <i>TSLP</i>, and <i>IL-25</i>) in mouse lung epithelial cells. The serine protease inhibitor phenyl-methane-sulfonyl fluoride (PMSF) inhibited ES protein activity. ES proteins also stimulated dendritic cells and enhanced the differentiation of naive T cells into IL-4-secreting T cells. After repeated inoculation of the protease-activated receptor 2 knockout mouse with ES proteins, airway inflammation and Th2 immune responses were markedly reduced, but not to basal levels. Furthermore, asthma patients had higher <i>Acanthamoeba</i>-specific IgE titers than healthy controls and we found <i>Acanthamoeba</i> specific antigen from house dust in typical living room. Our findings suggest that <i>Acanthamoeba</i> elicits allergic airway symptoms in mice via a protease allergen. In addition, it is possible that <i>Acanthamoeba</i> may be one of the triggers human airway allergic disease.</p></div

ES protein-induced allergic airway inflammation is reduced in PAR2 KO mice.

<p>(A) Intranasal inoculation schedule for the ES protein model. (B) Airway resistance values in response to methacholine (0 to 50 mg/ml). (C) Differential cell count in 800 μl BAL after Diff-Quik staining. (D) Tissue inflammation observed on stained lung sections (a and e: PBS-treated PAR2^+/+ mice; b and f: ES protein-treated PAR2^+/+ mice; c and g: PBS-treated PAR2^−/− mice; d and h; ES protein-treated PAR2^−/− mice; a, b, c and d: H&E-stained; e, f, g and h: PAS-stained). (E) Cytokine concentrations in BALF (a) and in the culture medium of CD3-stimulated lymphocytes isolated from LLNs (b) were measured. (F) Total and <i>Acanthamoeba</i>-specific IgE levels were measured in serum by ELISA. (*<i>p</i><0.05, **<i>p</i><0.01, ***<i>p</i><0.001; n = 3∼5, three independent experiments).).</p